Risk factors for delirium among hospitalized adults with COVID-19: A systematic review and meta-analysis of cohort studies

Serum Levels of Zinc and Copper in Patients with Endometrial Cancer: a Systematic Review and Meta-analysis

Endometrial cancer (EC) is the leading gynecologic cancer in developed nations. Recent studies suggest that trace elements like zinc and copper may be involved in cancer development due to their involvement in essential biological processes. However, there is inconsistency regarding their serum levels in EC patients. This review sought to systematically analyze and quantify the differences in serum concentrations of zinc and copper between patients with EC and healthy controls through a meta-analysis. A comprehensive search in PubMed, Embase, Scopus, and Google Scholar was performed. Studies comparing serum zinc and/or copper concentrations between confirmed EC patients and healthy controls were included. The quality of the papers was appraised using Newcastle-Ottawa Scale. Synthesis of data was done using standardized mean differences (SMD) at 95% confidence intervals (CIs) employing RevMan software. Five studies, including 433 patients with EC and 448 healthy controls, were analyzed. Meta-analysis showed a substantial decrease in serum zinc concentrations in EC patients against controls (SMD, - 0.91; 95% CI, [- 1.73, - 0.08]; p = 0.03). Serum copper levels were slightly higher in EC patients (SMD, 0.27; 95% CI, [- 0.66, 1.20]), but the difference was not statistically substantial (p = 0.57). The analysis showed reduced serum zinc levels in EC patients, suggesting the potential of zinc as a biomarker. The non-significant trend of higher copper levels requires further investigation to conclusively determine copper's role in EC. Future studies should explore the mechanisms underlying trace element imbalances.

Microbiome landscapes of the bladder, intestine, and vagina in bladder cancer: a systematic review

BACKGROUND

Microbiomes have been linked to oncogenesis, e.g. the intestinal microbiome and colon cancer or HPV-associated cervical cancer. A connection between microbiomes of different body cavities and tumor oncogenesis was shown. The gut microbiome's influence on bladder cancer was established, raising the question whether nearby microbiomes (rectum, vagina) also influence bladder cancer due to their proximity.

OBJECTIVE

Considering the influence of various body cavities and the broader microbial components, this systematic review aims to investigate differences in the bladder, vaginal, and intestinal microbiota-including bacterial, viral, fungal and archaea-between patients with bladder cancer and healthy controls.

METHODS

Databases (PubMed, Scopus, Embase) were searched until April 2022. Three types of studies were included: "(1) studies using bladder cancer and control groups (case-controlled studies) (2) studies that provided information on the presence or abundance of microbial taxa (3) studies that provided information on increased or decreased taxa in bladder cancer and/or control groups.". Risk of bias was assessed using the Newcastle Ottawa Scale.

RESULTS

Fourteen studies (695 samples: 403 bladder cancer, 292 controls) were analyzed. Bacterial taxa that have been detected in at least two studies, the genera Geobacillus and Rubrobacter were more frequently in bladder cancer patients; while Streptococcus and Roseomonas were more prevalent in controls. No consistent taxa were identified across stool or bladder tissue samples.

CONCLUSION

The microbiota in bladder cancer patients show significant variation across studies. Standardized methods and expanded investigations into viral and fungal components are needed to clarify the role of microbiota in bladder cancer.

Minimizing Redislocation Rates and Restoring Function After Patella Dislocation: A Critically Appraised Topic

CLINICAL SCENARIO

Patella dislocation is a common knee injury resulting in decreased function, increased knee pain, and a higher risk of recurrent patella dislocation. Patients with patella instability are treated surgically or conservatively with physical therapy to minimize redislocation risk and restore function.

CLINICAL QUESTION

In individuals with a patella dislocation, how does treatment (conservative therapy versus medial patellofemoral ligament [MPFL] surgery) affect redislocation rates and patient-perceived function?

SUMMARY OF KEY FINDINGS

This critically appraised topic included 3 studies assessing outcomes in individuals with patella instability treated with MPFL surgery or conservative management. Outcomes included comparing redislocation rates and Kujala scale perceived knee function between participant groups. Surgery included MPFL reconstruction (MPFL-R) in 1 randomized controlled trial and 1 prospective controlled trial and MPFL repair in another randomized controlled trial. Conservative treatment included physical therapy and bracing. All 3 studies demonstrated significantly lower redislocation rates in individuals managed with surgery versus conservative treatment. Reported knee function was significantly higher in the MPFL-R group compared with individuals conservatively managed at 2-year follow-up but not at 1 year. No significant difference in knee function was present between individuals receiving MPFL repair or conservative management at a 2-year follow-up.

CLINICAL BOTTOM LINE

There is moderate-level evidence to support a significant decrease in patella redislocation rates in individuals managed with MPFL surgery compared with conservative treatment. The reviewed studies suggest a significant improvement in patient-perceived knee function at 2 years following MPFL-R but no difference at 1 year following MPFL-R or 2 years after MPFL repair. Strength of Recommendations: Grade B evidence supports lower patella redislocation rates with MPFL surgery compared with nonsurgical treatment. Furthermore, this evidence suggests a potential benefit in perceived knee function 2 years after MPFL-R compared with conservative management.

Risk Factors and Predictors for Persistent Dyspnea Post-COVID-19: A Systematic Review

The most frequently reported post-coronavirus disease of 2019 (COVID-19) symptoms include shortness of breath, fatigue, and cognitive disturbances, with reports of persistent dyspnea ranging between 26% and 41%. There is an urgent need to understand the risk factors and predictors for persistent COVID-19 dyspnea in individuals at all levels of COVID-19 illness severity, to enable the implementation of targeted interventions for those likely to be most affected with persistent dyspnea. Thus, the purpose of this systematic review is to explore the risk factors and predictors that are associated with persistent dyspnea in the post-COVID-19 population. This review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered prospectively in PROSPERO as CRD42023466713. A search strategy was conducted across PubMed, CINAHL, Web of Science, and EMBASE databases, that included studies conducted from 2020 to March 2024. The Covidence platform was used for screening studies, scoring methodologic quality, and performing data extraction using a two-step independent review process. This review included 33 studies, addressing 83,920 participants across 20 countries. The strongest predictive risk factors for persistent dyspnea included the following: female sex, elevated body mass index, pulmonary comorbidities, pre-existing anxiety and depression, pre-COVID-19 physical limitations, the severity of the COVID-19 illness, and socioeconomic differences. Potential risk factors included increased age, smoking history, and COVID-19 variant type. The presence of biomarkers for persistent dyspnea in the post-COVID-19 population can be used by clinicians to prospectively identify those individuals who should be flagged. Early identification may then be leveraged for timely referral for prophylactic and rehabilitative interventions for dyspnea. A personalized plan to target those risk factors that are modifiable should follow.

Predictors of early neurological deterioration in patients with intracerebral hemorrhage: a systematic review and meta-analysis

BACKGROUND

Early neurological deterioration, a common complication in patients with intracerebral hemorrhage, is associated with poor outcomes. Despite the fact that the prevalence and predictors of early neurological impairment are widely addressed, few studies have consolidated these findings. This study aimed to systematically investigate the prevalence and predictors of early neurological deterioration.

METHODS

The PubMed, Embase, Cochrane Library, CIHNAL, and Web of Science databases were systematically searched for relevant studies from the inception to December 2023. The data were extracted using a predefined worksheet. Quality assessment was conducted using the Newcastle-Ottawa Scale. Two reviewers independently performed the study selection, data extraction, and quality appraisal. The pooled effect size and 95% confidence intervals were calculated using the STATA 17.0 software package.

RESULTS

In total, 32 studies and 5,014 patients were included in this meta-analysis. The prevalence of early neurological deterioration was 23% (95% CI 21-26%, p < 0.01). The initial NIHSS score (OR = 1.24, 95% CI 1.17, 1.30, p < 0.01), hematoma volume (OR = 1.07, 95% CI 1.06, 1.09, p < 0.01), intraventricular hemorrhage (OR = 3.50, 95% CI 1.64, 7.47, p < 0.01), intraventricular extension (OR = 3.95, 95% CI 1.96, 7.99, p < 0.01), hematoma expansion (OR = 9.77, 95% CI 4.43, 17.40, p < 0.01), and computed tomographic angiography spot sign (OR = 5.77, 95% CI 1.53, 20.23, p = 0.01) were predictors of early neurological deterioration. The funnel plot and Egger's test revealed significant publication bias (p < 0.001).

CONCLUSIONS

This meta-analysis revealed a pooled prevalence of early neurological deterioration of 23% in patients with intracerebral hemorrhage. The initial NIHSS score, hematoma volume, intraventricular hemorrhage, intraventricular expansion, hematoma expansion, and spot sign enhanced the probability of early neurological deterioration. These findings provide healthcare providers with an evidence-based basis for detecting and managing early neurological deterioration in patients with intracerebral hemorrhage.

Optimizing the safety and efficacy of the awake venovenous extracorporeal membrane oxygenation in patients with COVID-19-related ARDS

BACKGROUND

Maintaining the patient awake and not intubated during the venovenous extracorporeal membrane oxygenation (VV ECMO) reduces the risk of ventilation-induced lung injury in patients with ARDS. Currently, there is a lack of data on outcomes and complications associated with the awake ECMO approach.

OBJECTIVES

To evaluate outcomes and the occurrence of complications of awake ECMO approach guided by local safety protocol comprising ultrasound-guided cannulation, argatroban-based anticoagulation, respiratory support, and routine sedation targeted to reduce respiratory effort and keeping nurse-to-patient ratio of 1:1.

DESIGN

A single-center retrospective case series analysis.

METHODS

Consecutive patients with COVID-19-related acute respiratory distress syndrome (ARDS) (CARDS) treated by full awake VV ECMO approach from April 2019 to December 2023 were eligible.

RESULTS

Our center treated 10 patients (mean age 54.7 ± 11.6 years) with CARDS with an awake ECMO approach. The reasons for awake ECMO included the presence of barotrauma in six patients, a team consensus to prefer awake ECMO instead of mechanical ventilation in three patients, and the patient's refusal to be intubated in one case. Before ECMO, patients were severely hypoxemic, with a mean value of Horowitz index of 48.9 ± 9.1 mmHg and a mean respiratory rate of 28.8 ± 7.3 breaths per minute on high-flow nasal cannula or noninvasive ventilation support. The mean duration of awake VV ECMO was 558.0 ± 173.6 h. Seven patients (70%) were successfully disconnected from ECMO and fully recovered. Intubation from respiratory causes was needed in three patients (30%), all of whom died eventually. In total, three episodes of delirium, two episodes of significant bleeding, one pneumothorax requiring chest tube insertion, and one oxygenator acute exchange occurred throughout the 5580 h of awake ECMO. No complications related to cannula displacement or malposition occurred.

CONCLUSION

The awake ECMO strategy guided by safety protocol appears to be a safe approach in conscious, severely hypoxemic, non-intubated patients with COVID-19-related ARDS.